Boshuizen Margit, Binnekade Jan M, Nota Benjamin, van de Groep Kirsten, Cremer Olaf L, Horn Janneke, Schultz Marcus J, van Bruggen Robin, Juffermans Nicole P
Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Transfus Med Hemother. 2020 Feb;47(1):61-67. doi: 10.1159/000497123. Epub 2019 May 3.
Anemia of inflammation (AI) is the most common cause of anemia in the critically ill, but its diagnosis is a challenge. New therapies specific to AI are in development, and they require accurate detection of AI. This study explores the potential of parameters of iron metabolism for the diagnosis of AI during an ICU stay.
In a nested case-control study, 30 patients developing AI were matched to 60 controls. The iron parameters were determined in plasma samples during an ICU stay. Receiver operating characteristic curves were used to determine the iron parameter threshold with the highest sensitivity and specificity to predict AI. Likelihood ratios as well as positive and negative predictive values were calculated as well.
The sensitivity of iron parameters for diagnosing AI ranges between 62 and 76%, and the specificity between 57 and 72%. Iron and transferrin show the greatest area under the curve. Iron shows the highest sensitivity, and transferrin and transferrin saturation display the highest specificity. Hepcidin and ferritin show the lowest specificity. At an actual anemia prevalence of 53%, the diagnostic accuracy of iron, transferrin, and transferrin saturation was fair, with a positive predictive value between 71 and 73%. Combining iron, transferrin, transferrin saturation, hepcidin, and/or ferritin levels did not increase the accuracy of the AI diagnosis.
In this explorative study on the use of different parameters of iron metabolism for diagnosing AI during an ICU stay, low levels of commonly measured markers such as plasma iron, transferrin, and transferrin saturation have the highest sensitivity and specificity and outperform ferritin and hepcidin.
炎症性贫血（AI）是危重症患者贫血最常见的原因，但其诊断具有挑战性。针对AI的新疗法正在研发中，这些疗法需要准确检测出AI。本研究探讨了铁代谢参数在重症监护病房（ICU）住院期间诊断AI的潜力。
在一项巢式病例对照研究中，30例发生AI的患者与60例对照进行匹配。在ICU住院期间测定血浆样本中的铁参数。采用受试者工作特征曲线确定对预测AI具有最高敏感性和特异性的铁参数阈值。还计算了似然比以及阳性和阴性预测值。
铁参数诊断AI的敏感性在62%至76%之间，特异性在57%至72%之间。铁和转铁蛋白的曲线下面积最大。铁的敏感性最高，转铁蛋白和转铁蛋白饱和度的特异性最高。铁调素和铁蛋白的特异性最低。在实际贫血患病率为53%的情况下，铁、转铁蛋白和转铁蛋白饱和度的诊断准确性尚可，阳性预测值在71%至73%之间。联合铁、转铁蛋白、转铁蛋白饱和度、铁调素和/或铁蛋白水平并不能提高AI诊断的准确性。
在这项关于使用不同铁代谢参数在ICU住院期间诊断AI的探索性研究中，血浆铁、转铁蛋白和转铁蛋白饱和度等常用测量指标的低水平具有最高的敏感性和特异性，优于铁蛋白和铁调素。
